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Nefrologia clinica

FAVORABLE EFFECTS OF SOMATOSTATIN ANALOGUES AND MTOR INHIBITORS ON LV FUNCTION IN AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE: AN ECHOCARDIOGRAPHIC STUDY

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INTRODUCTION

Autosomal dominant polycystic kidney disease (ADPKD) is associated with early onset hypertension and left ventricular (LV) hypertrophy (Schrier RW. 2009 [1] (full text)). Novel therapies for ADPKD are somatostatin analogues, octreotide (S) and mammalian target of rapamycin inhibition (mTORi), rapamycin or everolimus (RE)(Colao A. 2009 [2] (full text)(Paoletti E. 2009 [3]). This study assesses the effects of S and RE on LV mass and function as compared with conventional therapy (P).

METHODS

57 ADPKD patients (mean age 38±8; male gender, 29; mean GFR 70.1±28.2 mL/min) were randomly assigned to group P(25), S (17) or RE(15). Patients underwent a clinical and echocardiography assessment at baseline and at 24 to 30 months follow up (mean, 26±3). LV mass was calculated according to Devereux formula and LV volumes and ejection fraction (EF) according to biplane Simpson’s algorithm. LV filling was assessed by the analysis of diastolic mitral flow velocity curves and pulmonary vein flow velocity curves. By tissue Doppler imaging mitral annulus early diastolic velocity peak (Ea) was also measured.

RESULTS AND CONCLUSIONS

The 80% of P group, 52% of S, 93%of RE had hypertension; the 80% of P group, 40% of S and 87% of RE were under treatment with ACEi or ARBs. At baseline, blood pressure and heart rate were comparable among groups (Figura 1). S patients had lower (p<0.01) LV mass than the other two groups (P,105± 17g/m2; S,94± 16 g/m2, R, 118± 24 g/m2) while there were not differences between groups in EF and parameters of LV diastolic function. In each group there was no change in LV mass and EF as compared with baseline. Patients of P group exhibited an increase in the ratio between mitral early diastolic flow velocity peak and Ea (p <0.001) and a longer duration of pulmonary vein reverse flow at atrial contraction (P<0.001), indicative of a worsening in LV diastolic function (Figure 2). This study suggest that a deterioration in LV diastolic function occurs over time in patients with ADPKD. Both octreotide and mTORi seem to have a protective role.

BibliografiaReferences

[1] Schrier RW Renal volume, renin-angiotensin-aldosterone system, hypertension, and left ventricular hypertrophy in patients with autosomal dominant polycystic kidney disease. Journal of the American Society of Nephrology : JASN 2009 Sep;20(9):1888-93 (full text)

[2] Colao A, Auriemma RS, Galdiero M et al. Effects of initial therapy for five years with somatostatin analogs for acromegaly on growth hormone and insulin-like growth factor-I levels, tumor shrinkage, and cardiovascular disease: a prospective study. The Journal of clinical endocrinology and metabolism 2009 Oct;94(10):3746-56 (full text)

[3] Paoletti E, Cannella G Reducing the risk of left ventricular hypertrophy in kidney transplant recipients: the potential role of mammalian target of rapamycin. Transplantation proceedings 2009 Jul-Aug;41(6 Suppl):S3-5

release  1
pubblicata il  27 settembre 2012 
da Visciano B¹, Pisani A¹, Ruggenenti P², Perico N², Mozzillo GR¹, Rossano R¹, Sabbatini M¹, Assante di Panzillo E³, Spinelli L³
(¹Cattedra di Nefrologia, Università degli Studi di Napoli Federico II; ² Clinical Research Center for Rare Diseases Aldo & Cele Daccò, Mario Negri Institute for Pharmacological Research; ³ Dipartimento di Medicina Clinica Scienze Cardiovascolari e Immunologiche, Università degli Studi di Napoli Federico II)
Parole chiave: analoghi somatostatina, funzione ventricolare diastolica, m tor inhibitors, massa ventricolare sinistra, nefropatie cistiche, rene policistico
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